Current status + progress

The world made remarkable progress in child survival in the past few decades, and millions of children have better survival chances than in 1990—1 in 26 children died before reaching age 5 in 2017, compared to 1 in 11 in 1990. Moreover, progress in reducing child mortality has been accelerated in the 2000–2017 period compared with the 1990s, with the annual rate of reduction in the global under-five mortality rate increasing from 1.9 per cent in 1990–2000 to 4.0 per cent in 2000–2017. Despite the global progress in reducing child mortality over the past few decades, an estimated 5.4 million children under age 5 died in 2017—roughly half of those deaths occurred in sub-Saharan Africa. Mortality rates among older children and young adolescents (aged 5-14) also dropped by more than 50 per cent since 1990, yet almost one million children died in this age group in 2017 alone. The global burden of child deaths is a call for urgent and concerted action to further improve the survival chances of the world’s children.

Under-five mortality

The global under-five mortality rate declined by 58 per cent, from 93 deaths per 1,000 live births in 1990 to 39 in 2017. Despite this considerable progress, improving child survival remains a matter of pressing concern. In 2017 alone, roughly 15,000 under-five deaths occurred every day, an intolerably high number of largely preventable child deaths.

Most regions in the world and 144 out of 195 countries at least halved their under-five mortality rate from 1990-2017. Among all countries, more than a third (74) cut their under-five mortality by at least two-thirds over this same period – 33 of them are low- or lower-middle-income countries, indicating that, while the burden of child mortality is unevenly distributed throughout the world, improving child survival is possible even in resource-constrained settings.

Children continue to face widespread regional and income disparities in their chances of survival. Sub-Saharan Africa continues to be the region with the highest under-five mortality rate in the world—76 deaths per 1,000 live births. In 2017, 1 in 13 children in sub-Saharan Africa died before reaching her or his fifth birthday—14 times higher than the risk for children born in high-income countries. Disparities in child survival abound at the country level as well where the risk of dying before age 5 for a child born in the highest mortality country is about 60 times higher than in the lowest mortality country, and all six countries with mortality rates above 100 deaths per 1,000 live births are in sub-Saharan Africa.

With shifting demographics, the burden of child deaths in heaviest in sub-Saharan Africa. Approximately 80 per cent of all under-five deaths in the world occur in just two regions: sub-Saharan Africa (50 per cent) and South Asia (30 per cent). Due to growing child populations and a shift of the population distribution towards high-mortality regions, the share of global under-five deaths that occur in sub-Saharan Africa increased from 30 per cent in 1990 to 50 per cent in 2017 and is expected to increase even further in the next few decades—by 2050, an estimated 60 per cent of global under-five deaths will take place in sub-Saharan Africa.

Ending preventable child deaths worldwide will require targeted interventions to the age-specific causes of death among children and young adolescents. Despite strong advances in fighting childhood illnesses, infectious diseases, which disproportionately affect children in poorer settings, remain highly prevalent, particularly in sub-Saharan Africa. Globally, pneumonia, diarrhoea and malaria remain among the leading causes of death among children under age 5 – accounting for about 30 per cent of global under-five deaths. The leading causes of death among children under age 5 in 2016 included preterm birth complications (18 per cent), pneumonia (16 per cent), intrapartum-related events (12 per cent), congenital abnormalities (9 per cent), diarrhoea (8 per cent), neonatal sepsis (7 per cent) and malaria (5 per cent).[i]

Notes on the data

Definition of indicators

Under-five mortality rate: Probability of dying between birth and exactly 5 years of age, expressed per 1,000 live births.

Infant mortality rate: Probability of dying between birth and exactly 1 year of age, expressed per 1,000 live births.

Neonatal mortality rate: Probability of dying during the first 28 days of life, expressed per 1,000 live births.

Probability of dying among children aged 5–14: Probability of dying at age 5–14 years expressed per 1,000 children aged 5.

Data sources and methodology

If each country had a single source of high-quality data covering the last few decades, reporting on child mortality levels and trends would be straightforward. But few countries do, and the limited availability of high-quality data over time for many countries makes generating accurate estimates of child mortality a considerable challenge.

Nationally representative estimates of child mortality can be derived from several sources, including civil registration, censuses and sample surveys. Demographic surveillance sites and hospital data are excluded because they are rarely nationally representative. The preferred source of data is a civil registration system that records births and deaths on a continuous basis, collects information as events occur and covers the entire population. If registration coverage is complete and the systems function efficiently, the resulting child mortality estimates will be accurate and timely. However, many countries remain without viable or fully functioning vital registration systems that accurately record all births and deaths—only around 60 countries have such systems. Therefore, household surveys, such as the UNICEF-supported Multiple Indicator Cluster Surveys and the US Agency for International Development–supported Demographic and Health Surveys, which ask women about the survival of their children, are the basis of child mortality estimates for most developing countries.

The United Nations Inter-agency Group for Child Mortality Estimation (UN IGME) seeks to compile all available national-level data on child mortality, including data from vital registration systems, population censuses, household surveys and sample registration systems. To estimate the under-five mortality trend series for each country, a statistical model is fitted to data points that meet quality standards established by UN IGME and then used to predict a trend line that is extrapolated to a common reference year, set at 2016 for the estimates presented here. Infant mortality rates are generated by either applying a statistical model or transforming under-five mortality rates based on model life tables. Neonatal mortality rates are produced using a statistical model that uses national available data and estimated under-five mortality rates as input. Mortality rates among children aged 5–14 were produced by using a similar model as for under-five mortality. These methods provide a transparent and objective way of fitting a smoothed trend to a set of observations and of extrapolating the trend from the earliest available data point to the present. A more detailed explanation is available in the explanatory notes (available in Arabic, English, French, Spanish and Russian).

An overview on the methodology is available in this year’s UN IGME report.

To increase transparency of UN IGME’s methodology for child mortality estimation a peer-reviewed collection of articles is available through PLoS Medicine. Topics include: an overview of the child mortality estimation methodology developed by UN IGME, methods used to adjust for bias due to AIDS, estimation of sex differences in child mortality, and more. The collection was produced with support from and the independent Technical Advisory Group of IGME. Read more.

You, D. et al. Global, regional, and national levels and trends in under-5 mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Inter-agency Group for Child Mortality Estimation. The Lancet. 2015; 386: 2275–2286.

UNICEF, WHO, The World Bank and UN Population Division, Levels and Trends of Child Mortality in 2006: Estimates developed by the Inter-agency Group for Child Mortality Estimation’, New York, 2007.Working Paper [PDF]